Androgenetic alopecia (female pattern)

What is female androgenetic alopecia?

Female androgenetic alopecia is a type of non-scarring alopecia with typical symptoms of diffuse, progressive hair loss in the central region of the scalp. It generally preserves the frontal hairline and leads to the characteristic widening of the central parting line, as described in the Ludwig classification or the Sinclair scale. 

The prevalence of female androgenetic alopecia increases with age, particularly after the age of 40 and following menopause. However, it may also occur in younger women, even from puberty.

Signs and symptoms of female androgenetic alopecia

Characteristic signs of female androgenetic alopecia are progressive hair thinning and reduced density in the upper scalp. Widening of the central parting line and increased visibility of the scalp are common, while the frontal hairline is usually preserved. Unlike male androgenetic alopecia, hair loss is more diffuse and rarely results in completely bald areas.

Causes of female androgenetic alopecia

Female androgenetic alopecia is influenced by genetic predisposition and hormonal factors. It is also associated with conditions such as polycystic ovary syndrome, thyroid disorders, iron deficiency and other nutritional deficiencies.

Diagnosis of female androgenetic alopecia

Female androgenetic alopecia is diagnosed through clinical examination by a specialist, based on observation of the scalp. Trichoscopy is used to confirm the diagnosis. This test allows assessment of variability in hair shaft thickness, an increased number of miniaturised follicles, reduced hair density and the presence of follicular units containing fewer hairs. 

Treatment of female androgenetic alopecia

Treatment combines topical or oral therapies that help slow hair loss and strengthen the hair (e.g. topical or oral minoxidil) with antiandrogen therapy in women without contraindications and under medical supervision; correction of any existing deficiencies; as well as complementary therapies aimed at improving follicular quality (e.g., mesotherapy and platelet-rich plasma). In selected cases, hair transplantation may also be considered as a reconstructive option.